The focus ofthis project is to evaluate the feasibility and effectiveness of an out-patient, minimally invasive surgery to American Indian women from a rural reservation community in the Northern Plains who are suffering from stress urinary incontinence. This study is unique because it is the first research study in which epidemiological discovery will be followed by outpatient treatment for urinary incontinence in this population. There is little data on urinary incontinence with American Indian women, although they are faced with several of the risk factors for urinary incontinence, including high rates of parity, diabetes, and smoking (1,2). American Indian women who completed the Urinary Distress Inventory will be followed-up for possible treatment, which ultimately depends on the type, severity, and underlying cause of urinary Incontinence. Participants with moderate to severe stress incontinence wiii receive outpatient surgical interventions at Sanford Health in Sioux Falls, South Dakota. The surgery that will be used for this project is a procedure called the tension-free vaginal tape secure system (TVT System), a procedure that can be performed under local anesthesia and is completed in about 30 minutes. Patients will be followed-up at 1, 3, and 12 months after the initial procedure. A retrospective chart abstraction will be completed to compare this group of American Indian women receiving the TVT procedure with other populations of women. While many other interventions for incontinence are focused on inpatient surgical interventions for stress urinary incontinence, an outpatient, office-based procedure from urogynecological specialists is essential for a rural and minority population of women. Ideally, this research will be the first step in designing larger, long-term clinical trials for American Indian women in the Northern Plains who are affected by urinary incontinence yet are not receiving the care they need. The greatest goal of the study is to evaluate an outpatient intervention with a group of rural, minority women with an overlooked but serious problem.